Concussion Practice Patterns among Speech-Language Pathologists

OBJECTIVE: To identify current SLP practice patterns in concussion care, clarify definitions of common cognitive retraining terminology, and establish areas of growth in clinical practice and research. METHOD: An online 10 question survey to collect data on assessment and practice components. Total 79 respondents from ASHA Special Interest Group 2 Neurogenic Communication Disorders website participated. Data were analyzed using descriptive statistics. RESULTS: Patient education and symptom management were regular components of cognitive retraining with concussion. Smaller percentage included cognitive endurance building. Further analysis identified variation in how clinicians defined terms: patient education, symptom management, and cognitive endurance building. Discrepancies noted with diagnostic tools, with one quarter using screening tools as primary assessment. CONCLUSION: Strong knowledge base to support differential diagnosis and therapeutic plan is critical to optimize outcomes in concussion care. Consistency with terminology use can reduce the risk of confusion but also support the value of what SLPs contribute to an interdisciplinary concussion team.

Effects of Electrical Stimulation in People with Post-Concussion Syndromes: A Pilot Study

Post-concussion syndrome (PCS) is a complex disorder with various symptoms. There is limited evidence to support that any intervention enhances recovery after a concussion. This pilot study aimed to examine the efficacy of neck paraspinal muscles electrical stimulation (ES) in conjunction with physical therapy (PT) on reducing the severity of post concussive symptoms. Twenty-four individuals with PCS were randomly assigned to the ES group (PT + ES) or the control group (PT only). Both groups received the intervention twice a week for eight weeks. Clinical measures including the Concussion Signs/Symptoms Checklist, balance error scoring system, King-Devick test, ImPACT, and the Standardized Assessment of Concussion were used to evaluate the symptoms. We investigated the recovery rate by calculating slopes of changes over time for each participant. A changing slope was derived by linearly fitting the symptoms severity over time with the initial severity score as the intercept. Significant overall improvement was observed in both groups after the interventions. There was no significant difference seen in total symptom recovery rate between two groups (-1.49 ± 1.59 versus -1.2 ± 1.56, p = 0.32). The cognitive symptoms recovery rate of the ES group was faster than the control group (-0.5 ± 0.49 and -0.13 ± 0.46 respectively, p = 0.04). Physical therapy targeting the cervical region is beneficial for persons with PCS. Moreover, peripheral electrical stimulation on the paraspinal muscles surrounding the neck region could potentially advance the cognitive function recovery of persons with PCS.

The Clinical Value of the Self-Administered Kamath and Stothard’s Questionnaire in the Diagnostics of Carpal Tunnel Syndrome

The clinician-administered Kamath and Stothard’s questionnaire is a recommended tool for assessing Carpal Tunnel Syndrome (CTS). The authors investigated whether the self-administered Kamath and Stothard’s questionnaire (KSQ) can categorize the severity of CTS according to the Nerve Conduction Study (NCS) and predict the outcome of Carpal Tunnel Release (CTR). One hundred and forty-two consecutive patients were enrolled in this prospective study, who completed the KSQ and were referred for NCS. Symptom relief after CTR was considered as the reference standard. KSQ’s scores were compared with the severity of CTS confirmed by NCS and the effectiveness of the surgery, Sensitivity and Positive Predictive Value (PPV) of the KSQ was calculated. The sensitivity of KSQ in each NCS severity category (mild, moderate, and severe CTS) was low (11.9% - 50.0%), however, the sensitivity and PPV of KSQ in the moderate + severe CTS category was 88.9% and 95.5%. The KSQ score of 5 or greater was found to be correlated with a successful CTR (sensitivity 92.8%, PPV of 90.2%). The study revealed that the KSQ with a score of 5 or greater is able to distinguish the mild conditions from moderate and severe ones. The KSQ’s score of 5 or greater also can predict the successful outcome of CTR. The authors believe that in addition to reducing the duration and cost of diagnostics, the KSQ can also reduce patient appointments and clinic time. Application of the KSQ may be of paramount importance in the current Covid pandemic era.